Readiness to Change

Are You Ready to Lose Weight?

written by Dr Gary Mendoza

This may seem like a strange question but actually it is very relevant. My research has shown that in some cases men will employ a personal trainer with the main aim being to lose weight. However, when I psychometrically tested these men to assess their readiness to change, in some cases they were not ready to change. You would think that this is counterintuitive as surely someone going to a personal trainer with this goal in mind would be ready to change. Well the assessment proved to be correct because based on the scores from the psychometric tests I was able to predict which men would be successful in their quest to lose weight. It would seem that the men that did not lose weight had other motives either conscious or subconscious, for going to see the personal trainer. It would be interesting to see how many people when told by their doctors that they need to lose weight are actually psychologically ready to engage in this process. My feeling is that a high proportion would not be ready.

So this brings me to my main point and that is that all personal trainers, weight loss counsellors, doctors and anyone else involved in the weight loss industry need to consider the stage of change that a client is in. The stage of change model of Prochaska et al. (1992) was designed for application to addictive behaviours but has also been widely applied to weight management. The stage of change model forms part of the transtheoretical model (TTM). This is a multi-stage psychological model that makes the assumption that behaviour change is a multi-stage process and the influence of behaviour change will vary according to the stage of change that an individual is currently in. The TTM encompasses a number of theoretical concepts and these include:

Decisional Balance

Processes of Change

Self-efficacy

There are reliable psychometric tests that can be used to measure each of these concepts. My research has used these tests and the theory has stood up well to what actually occurred with men entering a weight management programme. Initial assessment was used to screen subjects to see if they were in the correct stage of change (preparation/action) and also that they had the correct degree of efficacy and their decisional balance was also congruent with change. Providing the subjects achieved the correct entry scores they were admitted to the programme. This programme achieved an 86% success rate.

The other very useful aspect of employing psychometric testing was that the subjects could be screened throughout the programme. This allowed the trainers to pick up very early on if somebody was becoming demotivated and allowed early intervention. A lot of weight loss programmes concentrate on nutrition and/or exercise and activity but very few consider behavioural readiness. These tests are not difficult to administer and provided that you are trained in how to score and then interpret the data they are very useful tools for a weight management programme.

There are a number of challenges that this does present however. First, what do you do if an individual is not ready to change? In other words how do you move someone to the correct stage of change? This requires some expert psychological input, and is not an easy skill to master. The second challenge is that for weight management to be successful you have to achieve a lifestyle change. By inference this means you have to establish new habits, for both nutrition and activity. To be able to measure if a programme is successful we need to be able to measure whether these new behaviours have become a habit. Verplanken has undertaken a lot of work in this field with some promising results.

I have now produced a two day workshop that looks at how to administer and interpret the psychometric tests as well as considers a number of psychological skills associated with behaviour change such as motivational interviewing. The other aspect that is considered is what should be included in a weight management course as the peer reviewed literature highlights some clear elements that must be included for a weight management programme to be successful.

Anyone involved with weight management programmes should be asking themselves have they assessed the client’s readiness to lose weight. If you haven’t my research would suggest that you may be doomed to fail. If the client is not ready to change psychologically then you are very likely to fail. Certainly as a personal trainer this could be disastrous, as you can guarantee this client will then tell everyone that it was your fault and that you were not that good a trainer. Remember bad news travels fast and is difficult to counter. Weight management programmes should be multi-dimensional and include nutrition education, advice on getting active and exercise and finally psychometric assessment. These three elements should each receive equal attention in order to maximise the chances of success.